30 9 69 11 A. T. Co. Tar & Nicotine Change Form
63 15 71 18 7/ 24/ 90
52 16 58 18 Date
37 22 54 25 CARLTON 100's FMSP
16 23 31 25 Brand & Style
64 29 68 31 To
27 29 33 31 From
16 32 27 37 Tar (Mg /Cigt)
34 32 45 36 Nicotine (Mg /Cigt)
53 32 64 37 Tar (Mg /Cigt)
71 32 82 37 Nicotine (Mg/ /Cigt)
20 38 21 40 3
37 38 40 40 0 .3
74 38 78 40 0 .2
56 39 58 40 2
58 42 76 45 
45 43 55 45 Signature
24 54 62 56 Use Separate Form For Each Change
16 54 22 56 NOTE:
